Doctors Slowly Accept Health Information Exchanges

More practices plan to join HIEs, but rise is slow, and far more hospital-owned than private practices are interested, says study.

6 HIE Vendors: How They Measure Up

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Nearly half of physician practices plan to join some kind of health information exchange (HIE), according to the fifth annual survey of ambulatory practice management systems and EHRs by HIMSS Analytics, the research arm of the Health Information Management and Systems Society (HIMSS). But far fewer practices actually participate in an HIE today, the findings show.

Among the 846 practices that responded to the survey were hospital owned and freestanding practices of all sizes, ranging from one-doctor offices to groups of 100 or more physicians. Forty-six percent of the respondents planned to join a HIE, with 19% preferring a state health information exchange, 16% wanting an HIE that was part of a hospital or healthcare system, and 11% endorsing a regional HIE. Thirty-seven percent said they had no such plans. In the "other" category (17%) were practices that already belonged to exchanges and respondents who were unsure, HIMSS Analytics executives told InformationWeek Healthcare.

Of the privately owned practices, just 39% said they planned to join an HIE; 46% had no such plans. In contrast, 62% of hospital-owned groups said their organization planned to participate in an exchange, and just 14% did not. Notably, 25% of the hospital-owned practices expected to be part of a hospital system HIE, vs. just 13% of the freestanding practices.

Brendan Fitzgerald, research director of HIMSS Analytics, said that this was part of the reason for the disparity between the two types of practices. In addition, he noted, "Much of the decision making in that area is out of the hands of the individual hospital-owned practice. The hospital would make that decision. On the freestanding side, they're deciding whether they want to engage in an HIE."

Overall, the percentage of practices that had HIE plans was only slightly higher this year than in 2012, when it totaled 43%.

Some other key findings of the HIMSS Analytics report:

-Private practices are using a great variety of EHRs, and they consider more EHRs when looking to purchase one than hospital-owned groups do.

-The EHR vendor with the highest market share among hospital-owned practices is Epic, with 33%. In the freestanding sector, Epic has only a 4% market share, and eClinicalWorks is the leader with 11%.

Fitzgerald noted that hospital-owned practices have different priorities than private groups do, including the ability to communicate across care settings. So they require more "bells and whistles" in their EHRs. And in the ambulatory EHR market overall, he added, "there is still a high level of fragmentation."

The survey showed that a third of practices planned to purchase a new EHR, upgrade their system, or replace it. But despite evidence that many physicians are unhappy with their EHRs, only 6% are looking to replace them, according to the report.

Whether practices are hospital owned or freestanding, Fitzgerald said, "they've committed a lot of time and effort to making these EHR purchases, and they want to make it work. Given the effort, I don't think many people are jumping at the chance to 'rip and replace' and purchase a new system."

Within size categories, there were notable differences in what was driving EHR purchases. For example, 35% of practices with more than 100 doctors saw the ability to exchange patient data among facilities as the biggest driver, whereas that was the top goal in only 17% of all practices. Making their practice more efficient was more important to practices of three to 10 physicians than to respondents as a whole.

"Smaller practices want to be more efficient, but larger practices that serve larger communities have different parameters," Fitzgerald noted. "They want to be able to integrate seamlessly with larger organizations. It has to do with day-to-day workflow and how they want to utilize their EHR solution."

There was a more diverse set of vendors in the area of practice management (PM) systems than in the EHR arena. Fitzgerald said that was related to the fact that most practices have had PM systems longer than they've had EHRs. So when they bought EHRs, many of them kept their current PM systems and interfaced the two systems rather than buying an integrated solution.

Blaine Newton, senior VP of HIMSS Analytics, added that many practices held off on upgrading their PM systems when they were busy implementing EHRs. Now they're catching up, "and we're seeing pickup in practice management tools," he said. Neither executive believed that the impending transition to ICD-10 was the main motivating force in these investments.

It makes sense that more hospital owned practices would wantHIE participation compared to privately owned practices since they have adiffering goals when it comes to EHRs. Larger hospital owned practices would bemore inclined to the exchange of patient data among facilities while smallerprivately owned practices are focused on achieving greater efficiency in theirpractice. I think that with MU 2 around the corner though, we will see higherpercentages of the practices that participate in HIEs.

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